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Conway R, Esser S, Steptoe A, Smith AD, Llewellyn C. Content analysis of on-package formula labelling in Great Britain: use of marketing messages on infant, follow-on, growing-up and specialist formula. Public Health Nutr 2023; 26:1696-1705. [PMID: 36710005 PMCID: PMC10427444 DOI: 10.1017/s1368980023000216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore on-package formula messaging with reference to legislation and government-issued guidance in Great Britain (GB). DESIGN Formula products were identified, pictures of all sides of packs collated and on-package text and images were coded. Compliance with both GB legislation and guidance issued by the Department of Health and Social Care (DHSC) was assessed. SETTING All formula packs that were available for sale over the counter in GB between April and October 2020. PARTICIPANTS Formula packs (n 71) including infant formula, follow-on formula, growing-up formula and specialist formula were identified, coded and analysed. RESULTS In total, 41 % of formula packs included nutrition claims, and 18 % included health claims that may be considered non-permitted, according to DHSC guidance. Additionally, 72 % of products showed images considered 'non-permitted'. Breast Milk Substitute (BMS) legislation states infant and follow-on formula packs should be clearly distinguishable but does not provide criteria to assess similarity. Based on DHSC guidance, 72 % of infant and follow-on formula packs were categorised as showing a high degree of similarity. Marketing practices not covered by current legislation were widespread, such as 94 % of infant formula packs including advertisements for follow-on or growing-up formula. CONCLUSIONS Text and images considered non-permitted according to DHSC guidance for implementing BMS legislation were widespread on formula products available in GB. As terms such as 'similarity' are not defined in BMS legislation, it was unclear if breaches had occurred. Findings support the WHO call for loopholes in domestic legislation to be closed as a matter of urgency.
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Affiliation(s)
- Rana Conway
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sara Esser
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrew Steptoe
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Andrea D Smith
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Clare Llewellyn
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, UK
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Pomeranz JL, Chu X, Groza O, Cohodes M, Harris JL. Breastmilk or infant formula? Content analysis of infant feeding advice on breastmilk substitute manufacturer websites. Public Health Nutr 2023; 26:934-942. [PMID: 34517933 PMCID: PMC10346044 DOI: 10.1017/s1368980021003451] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate messages about infant feeding on breastmilk substitute (BMS) manufacturer websites directed at US caregivers and compare information and portrayals of breast-feeding/breastmilk with that of infant formula (IF) feeding. DESIGN We conducted a content analysis of US BMS companies' websites. A codebook was created through an iterative process to identify messages and images about breast-feeding/breastmilk and IF feeding, including benefits or issues associated with each, and direct-to-consumer marketing practices that could discourage breast-feeding. SETTING Data were collected in 2019-2020 and analysed in 2020-2021 for US websites of five IF manufacturers. PARTICIPANTS The websites of Similac, Enfamil and Gerber, which collectively represent approximately 98 % of the US IF market, and two US organic brands, Earth's Best and Happy Baby. RESULTS Websites contained more messages about breast-feeding/breastmilk than IF but were significantly more likely to mention benefits to baby of IF (44 %) than breast-feeding/breastmilk (<26 %), including significantly more statements that IF provides brain, neural and gastrointestinal benefits; 40 % of breast-feeding/breastmilk content was dedicated to breast-feeding problems (e.g. sore nipples). Twice as many screenshots compared IF brands favourably to breastmilk than as superior to other brands. Certain companies displayed images indicating ease of IF feeding and difficulty of breast-feeding. CONCLUSIONS Substantial messaging on BMS manufacturer websites encouraged IF feeding and discouraged breast-feeding. Health professionals should discourage their patients from visiting these websites and the US government should regulate misleading claims. Companies should refrain from providing breast-feeding advice and align their US marketing with the International Code of Marketing of Breast-milk Substitutes.
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Affiliation(s)
| | - Xiangying Chu
- School of Global Public Health, New York University, New York, NY, USA
| | - Oana Groza
- School of Global Public Health, New York University, New York, NY, USA
| | - Madeline Cohodes
- School of Global Public Health, New York University, New York, NY, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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3
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Cheung KY, Petrou L, Helfer B, Porubayeva E, Dolgikh E, Ali S, Ali I, Archibald-Durham L, Brockway MM, Bugaeva P, Chooniedass R, Comberiati P, Cortés-Macías E, D'Elios S, Feketea G, Hsu P, Kana MA, Kriulina T, Kunii Y, Madaki C, Omer R, Peroni D, Prokofiev J, Simpson MR, Shimojo N, Siziba LP, Genuneit J, Thakor S, Waris M, Yuan Q, Zaman S, Young BE, Bugos B, Greenhawt M, Levin ME, Zheng J, Boyle RJ, Munblit D. Health and nutrition claims for infant formula: international cross sectional survey. BMJ 2023; 380:e071075. [PMID: 36792145 PMCID: PMC9930154 DOI: 10.1136/bmj-2022-071075] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims. DESIGN International cross sectional survey. SETTING Public facing and healthcare professional facing company owned or company managed formula industry websites providing information about products marketed for healthy infants delivered at full term in 15 countries: Australia, Canada, Germany, India, Italy, Japan, Nigeria, Norway, Pakistan, Russia, Saudi Arabia, South Africa, Spain, the United Kingdom, and the United States in 2020-22. MAIN OUTCOME MEASURES Number and type of claims made for each product and ingredient. References cited were reviewed and risk of bias was assessed for registered clinical trials using the Cochrane risk of bias tool, and for systematic reviews using the Risk Of Bias in Systematic reviews tool. RESULTS 757 infant formula products were identified, each with a median of two claims (range from 1 (Australia) to 4 (US)), and 31 types of claims across all products. Of 608 products with ≥1 claims, the most common claim types were "helps/supports development of brain and/or eyes and/or nervous system" (323 (53%) products, 13 ingredients), "strengthens/supports a healthy immune system" (239 (39%) products, 12 ingredients), and "helps/supports growth and development" (224 (37%) products, 20 ingredients). 41 groups of ingredients were associated with ≥1claims, but many claims were made without reference to a specific ingredient (307 (50%) products). The most common groups of ingredients cited in claims were long chain polyunsaturated fatty acids (278 (46%) products, 9 different claims); prebiotics, probiotics, or synbiotics (225 (37%) products, 19 claims); and hydrolysed protein (120 (20%) products, 9 claims). 161/608 (26%) products with ≥1 claims provided a scientific reference to support the claim-266 unique references were cited for 24 different claim types for 161 products. The reference types most frequently cited were clinical trials (50%, 134/266) and reviews (20%, 52/266). 28% (38/134) of referenced clinical trials were registered, 14% (19/134) prospectively. 58 claims referred to 32 registered clinical trials, of which 51 claims (27 trials) related to a randomised comparison. 46 of 51 claims (90%) referenced registered clinical trial outcomes at high risk of bias, and all cited systematic reviews and pooled analyses, carried a high risk of bias. CONCLUSIONS Most infant formula products had at least one health and nutrition claim. Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.
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Affiliation(s)
- Ka Yan Cheung
- Faculty of Medicine, Imperial College London, London, UK
| | - Loukia Petrou
- Faculty of Medicine, Imperial College London, London, UK
| | - Bartosz Helfer
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
- Meta Research Centre, University of Wroclaw, Wroclaw, Poland
| | - Erika Porubayeva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Elena Dolgikh
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Sana Ali
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Insaf Ali
- College of Medicine, King Faisal University, Kingdom Saudi Arabia
| | - Lindsay Archibald-Durham
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Polina Bugaeva
- Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Rishma Chooniedass
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, Winnipeg, BC, Canada
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Erika Cortés-Macías
- Institute of Agrochemistry and Food Technology (IATA-CSIC), National Research Council, 46980 Valencia, Spain
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | - Gavriela Feketea
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, "Karamandaneio," Children Hospital, Patras, Greece
- Department of Pharmacology, "luliu Hatieganu" University of Medicine and Pharmacy, 400337, Cluj-Napoca, Romania
| | - Peter Hsu
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Musa Abubakar Kana
- Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
| | - Tatiana Kriulina
- Department of Paediatrics and Paediatric Rheumatology, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Yuzuka Kunii
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Comfort Madaki
- Kaduna Infant Development (KID) Birth Cohort Study Project, Kaduna, Nigeria
| | - Rihab Omer
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, Pisa, Italy
| | | | - Melanie Rae Simpson
- Department of Public Health and General Practice, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St Olavs Hospital, Trondheim, Norway
| | - Naoki Shimojo
- Centre for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Linda P Siziba
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Sohini Thakor
- Faculty of Medicine, Imperial College London, London, UK
| | - Marium Waris
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Quan Yuan
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sadia Zaman
- Faculty of Medicine, Imperial College London, London, UK
| | - Bridget E Young
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Brighid Bugos
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthew Greenhawt
- Department of Pediatrics, Section of Allergy/Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael E Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Jonathan Zheng
- Department of Electrical and Electronic Engineering, Imperial College London, London, UK
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London W2 1PG, UK
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
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Capili DIS, Datu-Sanguyo J, Mogol-Sales CS, Zambrano P, Nguyen TT, Cashin J, Mathisen R. Cross-sectional multimedia audit reveals a multinational commercial milk formula industry circumventing the Philippine Milk Code with misinformation, manipulation, and cross-promotion campaigns. Front Nutr 2023; 10:1081499. [PMID: 36819680 PMCID: PMC9932888 DOI: 10.3389/fnut.2023.1081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
The Philippine Milk Code was enacted in 1986 to protect breastfeeding and reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is categorized as "substantially aligned" with the International Code of Marketing of Breast-milk Substitutes ("the Code"), but its provisions are assessed as relatively weak in prohibiting promotion to the general public. The extent to which violations of the Philippine Milk Code persist in traditional media platforms and in the digital space has not been systematically explored. This study employed a cross-sectional multimedia audit to examine the marketing and promotion of products under the scope of the Code, as well as those regulated by the Philippine Milk Code. Through a media monitoring conducted from March to September 2018, a total of 430 unique television (n = 32), printed (n = 87) and online (n = 311) promotional materials were identified. A coding tool was used to analyze the content, including the marketing elements used in the materials. Our findings show that commercial milk formula (CMF) for children ≥36 months old was the most promoted type of product (n = 251); and staging of events (n = 211), provision of special discounts or financial inducements (n = 115) and the use of taglines (n = 112) were the most used marketing elements. Promotion of CMF for children <36 months old was uncommon, which supports the conclusion that there is broad compliance with the Philippine Milk Code in terms of the types of products promoted. However, analysis of marketing elements reveals that the CMF industry circumvents the Philippine Milk Code through the use of false and misleading health and nutrition claims, emotionally manipulative language in promotional materials, and cross-promotion. The findings indicate gaps in enforcement and regulatory measures that require urgent attention.
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Affiliation(s)
| | - Janice Datu-Sanguyo
- Alive & Thrive East Asia Pacific, FHI 360, Muntinlupa, Philippines,*Correspondence: Janice Datu-Sanguyo,
| | | | - Paul Zambrano
- Alive & Thrive East Asia Pacific, FHI 360, Manila, Philippines
| | - Tuan T. Nguyen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Jennifer Cashin
- Alive & Thrive East Asia Pacific, FHI 360, Washington, DC, United States
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
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Unar-Munguía M, Santos-Guzmán A, Mota-Castillo PJ, Ceballos-Rasgado M, Tolentino-Mayo L, Sachse Aguilera M, Cobo Armijo F, Barquera S, Bonvecchio A. Digital marketing of formula and baby food negatively influences breast feeding and complementary feeding: a cross-sectional study and video recording of parental exposure in Mexico. BMJ Glob Health 2022; 7:e009904. [PMID: 36343968 PMCID: PMC9594510 DOI: 10.1136/bmjgh-2022-009904] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/24/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is little evidence of the association between digital marketing of formula and baby food and infant and young child feeding (IYCF) practices. OBJECTIVE Assess parents' exposure to digital marketing of formula and baby food for children <2 years and its association with the purchase and IYCF practices in Mexico. METHODS Parents ≥18 years recruited from a market research panel completed an online survey (n=1074) and capture-on-screen (n=95) between December 2020 and January 2021. Logistic regressions were used to estimate the association between exposure to digital marketing of formula and baby foods with its purchase, motivation, consumption and IYCF practices. RESULTS Digital marketing of formula and baby food was self-reported by 93.9% of parents in the online survey and observed by 93.7% in the capture-on-screen. Recorded ads did not comply with the International Code of Marketing of Breast-milk Substitutes. Parents who self-reported seeing a higher versus lower number of ads were less likely to exclusive breast feed (OR=0.38; 95% CI: 0.19 to 0.78), and more likely to give mixed feeding (OR=2.59; 95% CI: 1.28 to 5.21), formula (OR=1.84; 95% CI: 1.34 to 2.53), processed foods (OR=2.31; 95% CI: 1.59 to 3.32) and sugary drinks (OR=1.66; 95% CI: 1.09 to 2.54). Higher exposure to ads was associated with a higher chance of purchasing products motivated by nutritional (OR=2.1; 95% CI: 1.32 to 3.28) and organic claims (OR=2.1; 95% CI: 1.21 to 3.72). CONCLUSIONS Digital marketing of formula and baby food may negatively influence IYCF and should be regulated to ensure children's nutrition and health.
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Affiliation(s)
- Mishel Unar-Munguía
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Andrea Santos-Guzmán
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Lizbeth Tolentino-Mayo
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | | | - Simón Barquera
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Anabelle Bonvecchio
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
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Methodologies for Monitoring the Digital Marketing of Foods and Beverages Aimed at Infants, Children, and Adolescents (ICA): A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158951. [PMID: 35897321 PMCID: PMC9330739 DOI: 10.3390/ijerph19158951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022]
Abstract
While television has been the most widely used medium for food and beverage marketing, companies are shifting in favor of digital media. The ubiquitous digital marketing of breast-milk substitutes (BMS) and foods and beverages high in saturated fat, salt, and/or free sugars (FBHFSS) has been considered a powerful environmental determinant of inadequate dietary practices during infancy, childhood, and adolescence. The scoping review’s aim was to systematically identify and map the types of methodologies available to monitor the digital marketing of foods and beverages targeting infants, children, and adolescents (ICA) worldwide. Research evidence published from 2011 to October 2021 was examined using search strategies including multiple databases and citation tracking. A total of 420 sources were evaluated, and 28 studies from 81 countries meeting the inclusion criteria were retained. Most of the studies (n = 24) documenting methodologies to monitor inappropriate digital marketing were published since 2015 and were primarily aimed at identifying the promotional techniques and nutritional content of FBHFSS targeting adolescents (n = 13). It is paramount to develop a feasible and scalable monitoring system to develop effective policies to protect parents and ICA from BMS and FBHSFF digital marketing.
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Becker GE, Zambrano P, Ching C, Cashin J, Burns A, Policarpo E, Datu‐Sanguyo J, Mathisen R. Global evidence of persistent violations of the International Code of Marketing of Breast-milk Substitutes: A systematic scoping review. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13335. [PMID: 35313063 PMCID: PMC9113471 DOI: 10.1111/mcn.13335] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/03/2023]
Abstract
The influence of marketing on infant and young child feeding and health is well recognized, and an International Code was adopted by the World Health Assembly (WHA) in 1981 to reduce inappropriate marketing and protect breastfeeding. Yet the marketing and influencing continue. This scoping review systematically examined the published research evidence on the nature and extent of exposure to International Code violations from 1981 to August 2021. We used several search strategies involving multi-language databases, organization websites, citation tracking, and expert consultation, to find research items meeting our inclusion criteria. We evaluated 657 items and retained 153 studies from at least 95 countries in the review. The majority of the studies (n = 113) documenting exposure to inappropriate marketing were published since 2010. Studies reported a broad range of marketing violations targeting mothers and families, health workers, and the general public. Marketing via digital platforms and brand extension has become more frequent. The evidence shows the use of misleading and inaccurate labeling and health and nutrition claims in breach of the Code. Our review confirms that violations of the Code have not ceased and calls for renewed attention from the WHA and national governments to protect the health of children and their mothers.
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Affiliation(s)
| | - Paul Zambrano
- Alive & Thrive Southeast Asia/FHI 360ManilaPhilippines
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI 360WashingtonDistrict of ColumbiaUSA
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360WashingtonDistrict of ColumbiaUSA
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8
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Han S, Chen H, Wu Y, Pérez‐Escamilla R. Content analysis of breast milk substitutes marketing on Chinese e‐commerce platforms. MATERNAL & CHILD NUTRITION 2022; 18:e13332. [PMID: 35213768 PMCID: PMC8932694 DOI: 10.1111/mcn.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/16/2021] [Accepted: 01/26/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Shannon Han
- Department of Social and Behavioral Sciences, Laboratory of Epidemiology and Public Health, Yale School of Public Health Yale University New Haven Connecticut USA
| | - Huixi Chen
- International Peace Maternity and Child Health Hospital Shanghai Jiaotong University School of Medicine Shanghai China
| | - Yanting Wu
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development Fudan University Shanghai China
| | - Rafael Pérez‐Escamilla
- Department of Social and Behavioral Sciences, Laboratory of Epidemiology and Public Health, Yale School of Public Health Yale University New Haven Connecticut USA
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9
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Jones A, Bhaumik S, Morelli G, Zhao J, Hendry M, Grummer-Strawn L, Chad N. Digital Marketing of Breast-Milk Substitutes: a Systematic Scoping Review. Curr Nutr Rep 2022; 11:416-430. [PMID: 35507274 PMCID: PMC9066994 DOI: 10.1007/s13668-022-00414-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Globally, too few children are breastfed as recommended. Commercial promotion of breast-milk substitutes (BMS) is one factor undermining breastfeeding globally. Although the International Code of Marketing of BMS prohibits all forms of marketing, promotion has been observed in digital environments. We aimed to understand the scope and impact of digital marketing for the promotion of BMS. RECENT FINDINGS BMS are promoted strategically and in an integrated fashion across multiple digital channels (social media, manufacturer websites, online retailers, blogs, mobile apps and digital streaming services). Traditional marketing strategies like gifts, discounts and coupons are also disseminated digitally. Data mining, real-time direct-to-consumer advertising and partnering with peer-group social media influencers are additional avenues. Exposure to digital marketing is common. Research on the impact of digital marketing is scarce, but its negative impact on breastfeeding intention and initiation has been documented. Case reports from marketing industry press corroborate academic evidence by highlighting the benefits of digital marketing to BMS companies in recruiting new users and increasing sales. To protect and promote breastfeeding, coordinated global action and strengthened national measures will be needed to implement, monitor and enforce the International Code in a digital context. Further action could include voluntary restrictions on BMS marketing by social media platforms and greater use of government-led data and health privacy regulation.
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Affiliation(s)
- Alexandra Jones
- Food Policy Division, The George Institute for Global Health, UNSW, Level 5, 1 King St, Newtown, NSW 2042 Australia
| | - Soumyadeep Bhaumik
- Meta-Research and Evidence Synthesis Unit, The George Institute for Global Health, India, 308, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025 India
| | - Georgia Morelli
- Food Policy Division, The George Institute for Global Health, UNSW, Level 5, 1 King St, Newtown, NSW 2042 Australia
| | - Jing Zhao
- Food Policy Division, The George Institute for Global Health, UNSW, Level 5, 1 King St, Newtown, NSW 2042 Australia
| | - Miranda Hendry
- School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, NSW 2006 Australia
| | - Laurence Grummer-Strawn
- Actions in Health Systems Unit, Department of Nutrition and Food Safety, World Health Organization, Avenue Appia, 20, Ch-1211, 27 Geneva, Switzerland
| | - Nina Chad
- Actions in Health Systems Unit, Department of Nutrition and Food Safety, World Health Organization, Avenue Appia, 20, Ch-1211, 27 Geneva, Switzerland
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Granheim SI, Løvhaug AL, Terragni L, Torheim LE, Thurston M. Mapping the digital food environment: A systematic scoping review. Obes Rev 2022; 23:e13356. [PMID: 34519396 DOI: 10.1111/obr.13356] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/05/2021] [Accepted: 08/11/2021] [Indexed: 01/22/2023]
Abstract
Food environments are directly linked to diets and health outcomes such as overweight, obesity, and noncommunicable diseases. The digitalization of food environments is becoming a central issue in public health, yet little is known about this emerging field. We performed a systematic scoping review to map the research on the digital food environment and investigate how the eight dimensions of the food environment, according to an established framework (availability, prices, vendor and product properties, marketing and regulation, accessibility, affordability, convenience, and desirability), might be shifting in the context of a digital society. We searched MEDLINE, EMBASE, Scopus, and Web of Science for studies published between 2000 and 2019, using search terms covering digital technology and food environment, which yielded 13,580 unique records. Our analysis of 357 studies shows that digitalization is taking place in all dimensions of the food environment, and enabling the emergence of new forms of buying and selling food, such as online grocery shopping and online food delivery, which may be changing availability of foods and affecting the physical distance to shops and time allocated for shopping. Systematic reviews identified indicated that digital food marketing and social media can influence food choices, preferences and consumption. Our findings suggest that digital and physical food environments are interconnected and influencing one another, but the impact of the digital on health and nutrition is yet unclear.
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Affiliation(s)
- Sabrina Ionata Granheim
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Miranda Thurston
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Simmonds L, Brownbill AL, Zee A, Netting MJ. Health-related marketing messages on product labels of commercial infant and toddler food packaging in Australia: a cross-sectional audit. BMJ Paediatr Open 2021. [PMCID: PMC8672004 DOI: 10.1136/bmjpo-2021-001241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundProper nutrition in early childhood is essential to ensure optimal growth and development. Use of ‘better-for-you’ features on food packaging position products as healthier for children. This study aims to systematically explore the use of better-for-you labelling on infant and toddler food packaging.MethodsA cross-sectional audit of health and nutrition claims, text and images used as ‘better-for-you’ features present on infant and toddler food packaging. Data on infant and toddler food packaging were collected from five large grocery stores in Adelaide, Australia in 2019. The content of 282 unique commercial products (n=215 infant foods, n=67 toddler foods) were analysed for explicit and implicit features positioning them as better-for-you, including health and nutrition claims as well as text and images representing ‘natural.’ResultsAt least one feature of better-for-you positioning was identified on all food packaging coded. All products had characteristics coded as ‘natural’. Almost one-fifth (17%) of the products included statements in addition to mandatory allergen labelling that their products were ‘free from’ certain allergens, or gluten. One-third of the labels had statements related to enhancing development of taste, oro-motor skills and other aspects of childhood development. Of the fruit and vegetable-based infant foods displaying a sugar statement suggesting a low sugar content, 85% were sweetened with fruit puree.ConclusionsThe use of better-for-you features on infant and toddler food packaging is common and pervasive. Allergen-free and developmental claims are being used to position infant and toddler foods as better-for-you. Regulation of toddler food products separately from adult food is required, as is tighter regulation of the appropriate use of sugar and fruit puree statements on infant and toddler food packaging.
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Affiliation(s)
- Lucy Simmonds
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Aimee L Brownbill
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- Foundation for Alcohol Research and Education, Canberra, Canberra, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anthea Zee
- College of Nursing and Health Sciences, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Merryn J Netting
- Women and Kids; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Medicine; School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Dearlove T, Begley A, Scott JA, Devenish-Coleman G. Digital Marketing of Commercial Complementary Foods in Australia: An Analysis of Brand Messaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157934. [PMID: 34360227 PMCID: PMC8345376 DOI: 10.3390/ijerph18157934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
The digital marketing of commercial complementary foods (CCF) is an emerging area of concern in Australia. Although research into traditional methods has identified a range of problems, the marketing and messaging strategies employed within digital spaces have gone largely unscrutinized. This study sought to examine the methods used by CCF manufacturers to promote Australian baby foods and brands in a digital space. A multiple step approach was used to assess the CCF brands available in major Australian retailers, the social media platforms they used, and to thematically analyze the text and visual messages contained in posts published over a three-month period. Of the 15 brands identified, 12 had a digital presence, and all of these used Facebook. Four themes emerged from an analysis of 216 Facebook posts; (1) general product attributes, (2) socially desirable attributes (which included messaging related to taste (41%), self-feeding (29%) and fun (19%)), (3) concern-based attributes (including organic status (40%), age targets (39%) and additive-/allergen-free status (18%)) and (4) health-focused attributes (which included messaging related to healthy/nutritious ingredients (45%), and child development/growth (15%). Messages contained in Facebook posts were mostly positive brand/product aspects (Themes 1 and 2) or parental concern-based aspects (Theme 3 and 4). These themes match previous analyses of marketing content in traditional media and should be closely monitored due to the personalized nature of consumer social media interactions.
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Blackman KCA, Smiley S, Valentine W, Chaudhari L, Kwan P, Cotton-Curtis W, Saetermoe C, Chan T. The Earliest Food Deserts: Availability of Infant and Follow-on Formula, and Lactation Support Products among Stores in Black and Non-Hispanic White Zip Codes in Los Angeles County. Matern Child Health J 2021; 26:863-871. [PMID: 34170452 DOI: 10.1007/s10995-021-03196-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study investigates the availability, accessibility, and product depth of in-store infant feeding and galactagogues products in majority Black and majority white zip codes in Los Angeles County. METHODS A cross-sectional study was conducted to determine racial/ethnic neighborhood differences in the availability of infant and follow-on formula and galactagogues products in 47 retail stores in 21 zip codes. Store-level data were collected in June 2019 and an observational tool for galactagogues products and infant/follow-on formula (availability, accessibility, product depth) was employed at each store. RESULTS Most of the stores were grocery stores (87.2%). Stores in majority Black zip codes had less availability of infant formula ready-to-use (p = 0.001), less accessibility of follow-on powder (p = 0.028), and availability of galactagogues beverages (p = 0.036) versus majority white zip codes. Product depth (number of brands sold) of stores with one or more brands of the aforementioned products was consistently higher in majority white zip codes compared to majority Black zip codes. Stores in majority Black zip codes were most likely to have lower availability of infant formula and galactagogues products, an important part of the food environment for infant feeding options, in particular, for lactation support. CONCLUSIONS FOR PRACTICE Most studies investigating the association of the food environment and health outcomes have focused only on solid foods. However, additional food products (e.g., liquids, powders) may be contributors to extensive disparities in infant mortality between Black and white infants and may lead to health disparities beyond infant stage (e.g., children, adolescents, and adults). Lastly, for breastfeeding inequities to decrease, pregnant and postpartum Black persons need equitable access and education on safe and quality galactagogues products.
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Affiliation(s)
- Kacie C A Blackman
- Department of Health Sciences, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA.
| | - Sabrina Smiley
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto St, Los Angeles, CA, 90032, USA
| | - Wenonah Valentine
- iDREAM for Racial Health Equity, 811 W. 7th St, Los Angeles, CA, 90017, USA
| | - Lisa Chaudhari
- Department of Health Sciences, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA
| | - Patty Kwan
- Department of Health Sciences, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA
| | - Wyconda Cotton-Curtis
- Department of Health Sciences, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA
| | - Carrie Saetermoe
- Department of Psychology, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA
| | - Thomas Chan
- Department of Psychology, Health Equity Research and Education Center, California State University Northridge, 18111 Nordhoff St, Northridge, CA, 91330, USA
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Baker P, Russ K, Kang M, Santos TM, Neves PAR, Smith J, Kingston G, Mialon M, Lawrence M, Wood B, Moodie R, Clark D, Sievert K, Boatwright M, McCoy D. Globalization, first-foods systems transformations and corporate power: a synthesis of literature and data on the market and political practices of the transnational baby food industry. Global Health 2021; 17:58. [PMID: 34020657 PMCID: PMC8139375 DOI: 10.1186/s12992-021-00708-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources. RESULTS Global milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments. CONCLUSION The baby food industry uses integrated market and political strategies to shape first-foods systems in ways that drive and sustain milk formula market expansion, on a global scale. Such practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. New modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.
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Affiliation(s)
- Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | | | | | - Thiago M. Santos
- International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Paulo A. R. Neves
- International Centre for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Julie Smith
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Gillian Kingston
- Centre for Primary Care and Public Health, Queen Mary University, London, UK
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Mark Lawrence
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Benjamin Wood
- School of Health and Social Development, Deakin University, Geelong, Australia
| | - Rob Moodie
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David Clark
- Independent Consultant on Public Health Law, New York, USA
| | - Katherine Sievert
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Monique Boatwright
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - David McCoy
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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The Influence Mechanism of Reputation Information on the Formation of Safety Trust in Chinese Infant Milk Powder. Healthcare (Basel) 2020; 8:healthcare8020138. [PMID: 32443859 PMCID: PMC7349046 DOI: 10.3390/healthcare8020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/24/2022] Open
Abstract
Infant milk powder has always been one of the food categories most sensitive to safety reputation information. The safety reputation of Chinese infant milk powder has been seriously damaged due to the occurrence of safety accidents and the resulting consumers’ still-unrestored confidence is an important factor which restricts the dairy industry revitalization. Therefore, this paper analyzes the impact of reputation information on the formation of safety trust in Chinese infant milk powder, taking reputation information transmission as the starting point and consumer psychological perception as the researching perspective. A questionnaire survey was conducted and 685 valid questionnaires were collected. The structural equation model is adopted to verify the theoretical model and corresponding research hypothesis that reputation information affects the safety trust of Chinese infant milk powder. The reputation information transmitted between relatives and friends has a stronger effect on the formation of safety trust in Chinese infant milk powder than the media. The degree of media pursuit of “news effect” and negative word-of-mouth have a significant negative impact on the formation of safety trust in Chinese infant milk powder, while reputation quality, positive word-of-mouth and relationship strength have a significant positive impact on that. The quality of word-of-mouth perceived by consumers from highly involvement group, rational group, urban group and high-educated group has a stronger influence on the formation of safety trust. The degree of media pursuit of “news effect”, positive word-of-mouth, negative word-of-mouth and relationship strength perceived by consumers from low involvement group, emotional group, rural group and low-educated group have stronger influence on the formation of safety trust.
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Esbati A, Taylor J, Henderson A, Barnes M, Kearney L. Perspectives about the baby friendly hospital/health initiative in Australia: an online survey. Int Breastfeed J 2020; 15:23. [PMID: 32268920 PMCID: PMC7140552 DOI: 10.1186/s13006-020-00266-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence supports the health and economic benefits of breastfeeding, and the positive impact of the Baby Friendly Health Initiative (BFHI) on increasing breastfeeding rates and improving breastfeeding outcomes. The BFHI is a World Health Organization and United Nations International Children's Emergency Fund initiative to promote, support and maintain breastfeeding. The BFHI was updated in 2018 and includes the Ten Steps to Successful Breastfeeding (the Ten Steps 2018) and the International Code of Marketing of Breast-milk Substitutes (the WHO Code). Despite policy and guideline support for breastfeeding and the BFHI, there are currently only 70 accredited hospitals, healthcare centres and regional clusters in Australia, accounting for 23% of maternity facilities. This research aimed to explore health professionals and other stakeholders' perspectives on the uptake and implementation of the BFHI in Australia from an organisational change perspective. METHODS An online survey administered via relevant Australian-based professional associations was fully or partially completed by 332 participants who support mothers and newborns in their roles. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data. RESULTS The majority of participants supported legislating the WHO Code, closely monitoring BFHI compliance, ensuring sufficient knowledge about breastfeeding and the BFHI among staff, improving care within maternity facilities, continuous support of mothers' post-discharge, and improving social media support of breastfeeding. It was also perceived that an interdisciplinary team approach and multidisciplinary involvement were important requirements for successfully implementing the BFHI. There was no consensus among participants that Australian health policies support breastfeeding and the implementation of the BFHI. CONCLUSIONS This study emphasised the significance of legislation around the Code, executive and leadership support and culture, and providing adequate resources concerning uptake and implementation of the BFHI. Considering that uptake of the BFHI has been limited and no formal government support has been provided to further develop the BFHI and support the Code in Australia, findings of this research may help with potential future actions to facilitate the BFHI uptake and Code implementation.
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Affiliation(s)
- Anahita Esbati
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Jane Taylor
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Amanda Henderson
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Margaret Barnes
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, Australia
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Smith JP. A commentary on the carbon footprint of milk formula: harms to planetary health and policy implications. Int Breastfeed J 2019; 14:49. [PMID: 31798668 PMCID: PMC6882342 DOI: 10.1186/s13006-019-0243-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Infant formula requires mass production by the dairy industry, with plastic and other waste and degradation of land and waterways. Millions of babies, two thirds globally, now have milk formula, with breastfeeding in dramatic decline in Asia. Economic cost externalities and commercial incentives Economic thinking clarifies that markets are not perfect - price incentives can lead to excessive and inefficient environmental damage. Market prices paid to produce or use a commodity may not reflect its true resource costs. The ongoing global transition in infant and young child feeding (IYCF) toward milk formula use makes urgent the investigation of its environmental costs, including greenhouse gas (GHG) implications. Socially vulnerable populations are also particularly exposed to climate change risks, but have the least voice and agency. The important role of public health advocacy Few question the scale of the baby food industry, especially in major food exporting countries. Breastfeeding advocacy non-government organisations have led the investigations, and exposed the inequitable vulnerabilities. A ground-breaking study in 2016 showed emissions from just six Asia Pacific countries were equivalent to 6 billion miles of car travel. Each kilogram (kg) of milk formula generated 4 kg of (carbon dioxide (CO2) equivalent) greenhouse gas during production. Much of this was from unnecessary toddler formula. Recent research reveals that if looking at the full product lifecycle, including consumer use, GHG emissions per kg are actually three times higher than these pioneering estimates. Environment and health harms combined with economic evidence highlight the place for a strong public health response on this issue. Conclusion Formula feeding is a maladaptive practice in the face of contemporary global environmental and population health challenges. Breastfeeding protection, support and promotion helps to safeguard planetary and human health by minimising environmental harm. It is a beneficial response to concerns about disease burdens and climate change. Breastfeeding populations are more resilient in emergencies. Effective and cost-effective policies and interventions exist for increasing breastfeeding and reducing unnecessary use of formula. Implementing such measures presents a rare opportunity to both reduce the greenhouse gas problem and improve human nutrition, health, and health equity.
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Affiliation(s)
- Julie P Smith
- Research School of Population Health, Australian National University, Canberra, Australia
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Champeny M, Hou K, Diop EI, Sy Gueye NY, Pries AM, Zehner E, Badham J, Huffman SL. Prevalence, duration, and content of television advertisements for breast milk substitutes and commercially produced complementary foods in Phnom Penh, Cambodia and Dakar, Senegal. MATERNAL & CHILD NUTRITION 2019; 15 Suppl 4:e12781. [PMID: 31225708 PMCID: PMC6617818 DOI: 10.1111/mcn.12781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/07/2018] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
Promotion of breast milk substitutes (BMS) and inappropriate marketing of commercially produced complementary foods (CPCF), including through television, can negatively influence infant and young child feeding. The World Health Organization International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly (WHA) resolutions prohibit such advertising and require manufacturers and distributors to comply with its provisions; however, such regulations at national level may vary. Advertisements require Ministry of Health approval in Cambodia but are not regulated in Senegal. Television stations were monitored for 13 months in Phnom Penh and for 3 months in Dakar to assess advertisements for BMS and CPCF. Ten television channels (out of 16) in Phnom Penh and four (out of 20) in Dakar aired advertisements for BMS. Three and five channels, respectively, aired advertisements for CPCF. All BMS advertised in Phnom Penh were for children over 1 year of age. BMS products for children 6+ months of age and 1+ years of age were advertised in Dakar. Average air time for BMS advertisements was 189.5 min per month in Phnom Penh and 29.7 min in Dakar. Air time for CPCF advertisements averaged 3.2 min per month and 13.6 min, respectively. Fewer than half of BMS advertisements and three quarters of CPCF advertisements explicitly stated an age of use for products. Nutrition and health claims were common across BMS advertisements. This study illustrates the need to adopt, regulate, monitor, and enforce legislation prohibiting BMS promotion, as well as to implement regulations to prevent inappropriate promotion of CPCF.
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Affiliation(s)
| | - Kroeun Hou
- Helen Keller InternationalNew YorkNew YorkUSA
| | | | | | - Alissa M. Pries
- Helen Keller InternationalNew YorkNew YorkUSA
- London School of Hygiene and Tropical MedicineLondonUK
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Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices. Public Health Nutr 2018; 21:2689-2697. [PMID: 29973298 DOI: 10.1017/s1368980018001453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals. DESIGN Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis. SETTING Indonesian provinces of Jakarta, Banten and West Java. SUBJECTS Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents. RESULTS Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme. CONCLUSIONS Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.
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Berry NJ, Gribble KD. Health and nutrition content claims on websites advertising infant formula available in Australia: A content analysis. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27739216 DOI: 10.1111/mcn.12383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/13/2023]
Abstract
The use of health and nutrition content claims in infant formula advertising is restricted by many governments in response to WHO policies and WHA resolutions. The purpose of this study was to determine whether such prohibited claims could be observed in Australian websites that advertise infant formula products. A comprehensive internet search was conducted to identify websites that advertise infant formula available for purchase in Australia. Content analysis was used to identify prohibited claims. The coding frame was closely aligned with the provisions of the Australian and New Zealand Food Standard Code, which prohibits these claims. The outcome measures were the presence of health claims, nutrition content claims, or references to the nutritional content of human milk. Web pages advertising 25 unique infant formula products available for purchase in Australia were identified. Every advertisement (100%) contained at least one health claim. Eighteen (72%) also contained at least one nutrition content claim. Three web pages (12%) advertising brands associated with infant formula products referenced the nutritional content of human milk. All of these claims appear in spite of national regulations prohibiting them indicating a failure of monitoring and/or enforcement. Where countries have enacted instruments to prohibit health and other claims in infant formula advertising, the marketing of infant formula must be actively monitored to be effective.
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Affiliation(s)
- Nina J Berry
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Karleen D Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, New South Wales, Australia
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